Drug abuse
:This article is an overview of the nontherapeutic use of alcohol and drugs of abuse. For the mental health classification, see substance abuse. Drug abuse has a wide range of definitions related to taking a psychoactive drug or performance enhancing drug for a non-therapeutic or non-medical effect. Some of the most commonly abused drugs include alcohol, amphetamines, barbiturates, benzodiazepines, cocaine, methaqualone, and opium alkaloids. Use of these drugs may lead to criminal penalty in addition to possible physical, social, and psychological harm, both strongly depending on local jurisdiction.(2002). Mosby's Medical, Nursing, & Allied Health Dictionary. Sixth Edition. Drug abuse definition, p. 552. Nursing diagnoses, p. 2109. ISBN 0-323-01430-5. Other definitions of drug abuse fall into four main categories: public health definitions, mass communication and vernacular usage, medical definitions, and political and criminal justice definitions. It includes the following: * Alcohol abuse * Drug dependency * Inhalant abuse * Polydrug abuse An estimated 4.7% of the global population aged 15 to 64, or 185 million people, consume illicit drugs annually.The Global War on DrugsCombating Drug Abuse Public health definitions ] Public health practitioners have attempted to look at drug abuse from a broader perspective than the individual, emphasising the role of society, culture and availability. Rather than accepting the loaded terms alcohol or drug "abuse," many public health professionals have adopted phrases such as "alcohol and drug problems" or "harmful/problematic use" of drugs. The Health Officers Council of British Columbia — in their 2005 policy discussion paper, A Public Health Approach to Drug Control in Canada — has adopted a public health model of psychoactive substance use that challenges the simplistic black-and-white construction of the binary (or complementary) antonyms "use" vs. "abuse". This model explicitly recognizes a spectrum of use, ranging from beneficial use to chronic dependence (see diagram to the right). Medical definitions In the modern medical profession, the two most used diagnostic tools in the world, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) and the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD), no longer recognise 'drug abuse' as a current medical diagnosis. Instead, they have adopted substance abuse as a blanket term to include drug abuse and other things. However, other definitions differ; they may entail psychological or physical dependence, and may focus on treatment and prevention in terms of the social consequences of substance uses. Historical positions of the American Psychiatric Association In the early 1950s, the first edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders referred to both alcohol and drug abuse as part of Sociopathic Personality Disturbances, which were thought to be symptoms of deeper psychological disorders or moral weakness . By the third edition, in the 1980s, drug abuse was grouped into 'substance abuse'. In 1972, the American Psychiatric Association created a definition that used legality, social acceptability, and even cultural familiarity as qualifying factors: Historical positions of the American Medical Association In 1966, the American Medical Association’s Committee on Alcoholism and Addiction defined abuse of stimulants (amphetamines, primarily) in terms of ‘medical supervision’: Handbook on Drug and Alcohol Abuse The Handbook on Drug and Alcohol Abuse defines drug abuse as "nonmedical use of drugs, both drugs that have and those that do not have generally accepted medical value".Winger, Gail. (1992). A Handbook on Drug and Alcohol Abuse: The Biomedical Aspects. Oxford University Press. ISBN 0-19-506397-X Political and criminal justice definitions Most countries have legislation designed to criminalise some drug use. Usually however the legislative process is self-referential, defining abuse in terms of what is made illegal. The legislation concerns lists of drugs specified by the legislation. These drugs are often called illegal drugs but, generally, what was illegal is their unlicensed production, supply and possession. The drugs are also called controlled drugs or controlled substances. Abuse potential Depending on the actual compound, drug abuse may lead to health problems, social problems, physical dependence, or psychological addiction. Some drugs that are subject to abuse have central nervous system (CNS) effects, which produce changes in mood, levels of awareness or perceptions and sensations. Most of these drugs also alter systems other than the CNS. But, not all centrally acting drugs are subject to abuse, which suggests that altering consciousness is not sufficient for a drug to have abuse potential. Among drugs that are abused, some appear to be more likely to lead to uncontrolled use than others, suggesting a possible hierarchy of drug-induced effects relative to abuse potential.Jaffe, J.H. (1975). Drug addiction and drug abuse. In L.S. Goodman & A. Gilman (Eds.) The pharmacological basis of therapeutics (5th ed.). New York: MacMillan. pp. 284–324. Approaches to managing drug abuse In addition to being a major public health problem, some consider drug abuse to be a social problem with far-reaching implications. Stress, poverty, domestic and societal violence, and various diseases (i.e., injecting drug users as a source for HIV/AIDS) are sometimes thought to be spread by drug use. Studies have also shown that individuals dependent on illicit drugs experience higher rates of comorbid psychiatric syndromes.Diala, C. Muntaner, C. Walrath, C. (May, 2004). "Gender, occupational, and socioeconomic correlates of alcohol and drug abuse among U.S. rural, metropolitan, and urban residents". American Journal of Drug and Alcohol Abuse. Harm reduction One alternative involves replacing failed law enforcement policies with harm-reduction strategies, which focus on reducing the societal costs of drug abuse and other drug use. Techniques include education to avoid overdose, needle exchange programs to reduce the spread of blood-borne diseases, and opioid substitution therapy to reduce crime related to the procurement of drugs. This pragmatic approach is known as the harm reduction paradigm. Harm reduction also addresses special populations, such as drug-using parents, pregnant drug users and users with psychiatric comorbidity. The philosophy of harm reduction accepts that drug use is part of the community, but that it must be addressed as a public health issue rather than a criminal one.Phillips, Prashant. (Oct, 2004). "Care of Drug Users in General Practice: a harm reduction approach." Book review. Mental Health Practice 8:i2. p. 29. Harm-reduction measures are at odds with the prevailing framework of international drug control, which rests on law enforcement and the criminalization of behaviors related to illicit drug use. However, harm-reduction has had a notable impact and is slowly gaining popularity. In Brazil alone, a comprehensive harm-reduction and drug-access program successfully reduced AIDS mortality among injection drug users by 50%.Editorial. (Mar 1, 2005) "HIV, harm reduction and human rights/VIH, reduction des prejudices et droits de la personne." Canadian Medical Association Journal. 172:(5). p.605. Abstinence-Based Abstinence-based approaches set as a goal complete abstinence from all addictive substances, including both licit and illicit, prescribed and unprescribed. While the harm-reduction approach has been demonstrated to work well with opioids, the abstinence-based approach is the medical community standard of care for sedative (including alcohol) dependence. Medical treatment Beyond the sociological issues, many drugs of abuse can lead to addiction, chemical dependency, or adverse health effects, such as cancer or emphysema from cigarette smoking. Medical treatment therefore centers on two aspects: 1) breaking the addiction, 2) treating the health problems. Most countries have health facilities that specialize in the treatment of drug abuse, although access may be limited to larger population centers and the social taboos regarding drug use may make those who need the medical treatment reluctant to take advantage of it. For example, it is estimated that only fifteen percent of injection drug abusers thought to be in need are receiving treatment.Appel, P.W., Ellison, A.A., Jansky, H.K., Oldak, R. (Feb 2004). "Barriers to enrollment in drug abuse treatment and suggestions for reducing them: opinions of drug injecting street outreach clients and other system stakeholders". American Journal of Drug and Alcohol Abuse. Patients may require acute and long-term maintenance treatment and relapse prevention, complemented by suitable rehabilitation. Qureshi N.A., al-Ghamdy Y.S., al-Habeeb T.A. (2000). "Drug addiction: a general review of new concepts and future challenges". East Mediterr Health J. Jul;6(4):723-33. PMID 11794078 Pharmacotherapy The development of pharmacotherapies for drug dependency treatment are currently in progress. New immunotherapies that prevent drugs like cocaine, methamphetamine, phencyclidine, nicotine, and opioids from reaching the brain are in the early stages of testing as is ibogaine, an alkaloid found in the Tabernanthe iboga plant of West Central Africa. Medications such as Buprenorphine, which block the drugs active site in the brain are another new option for the treatment of opioid addiction. Depot forms of medications, which require only weekly or monthly dosing, are also under investigation. Traditionally, new pharmacotherapies are quickly adopted in primary care settings, however, drugs for substance abuse treatment have faced many barriers. Naltrexone, a drug originally marketed under the name "ReVia," and now marketed in intramuscular formulation as "Vivitrol" or in oral formulation as a generic, is a medication approved for the treatment of alcohol dependence. This drug has reached very few patients. This may be due to a number of factors, including resistance by Addiction Medicine specialists and lack of resources. Board on Behavioral, Cognitive, and Sensory Sciences and Education (BCSSE). (2004) New Treatments for Addiction: Behavioral, Ethical, Legal, and Social Questions. The National Academies Press. pp. 7–8, 140–141 Legal approaches :Related articles: Prohibition (drugs), Arguments for and against drug prohibition Most governments have designed legislation to criminalise certain types of drug use. These drugs are often called "illegal drugs" but generally what is illegal is their unlicensed production, distribution, and possession. These drugs are also called "controlled substances". Even for simple possession, legal punishment can be quite severe (including the death penalty in some countries). Laws vary across countries, and even within them, and have fluctuated widely throughout history. Attempts by government-sponsored drug control policy to interdict drug supply and eliminate drug abuse have been largely unsuccessful. In spite of the huge efforts by the U.S., drug supply and purity has reached an all time high, with the vast majority of resources spent on interdiction and law enforcement instead of public health.Wood, Evan, et al. (Apr 29, 2003). "Drug supply and drug abuse". Letters. Canadian Medical Association Journal 168:(9). See also: CMAJ, 2003;168(2):165-9. In the United States, the number of nonviolent drug offenders in prison exceeds by 100,000 the total incarcerated population in the EU, despite the fact that the EU has 100 million more citizens. Despite drug legislation (and some might argue because of it), large, organized criminal drug cartels operate world-wide. Advocates of decriminalization argue that drug prohibition makes drug dealing a lucrative business, leading to much of the associated criminal activity. Specific drugs of abuse * Anabolic steroid abuse See also * Codependency * Craving * Social issues References Further reading *Wood, Evan, et al. (Apr 29, 2003). "Drug supply and drug abuse". Letters. Canadian Medical Association Journal 168:(9). See also: CMAJ, 2003;168(2):165-9. See also U.S. Criminal Justice Policy Foundation *Diala, C. Muntaner, C. Walrath, C. (May 2004). "Gender, occupational, and socioeconomic correlates of alcohol and drug abuse among U.S. rural, metropolitan, and urban residents". American Journal of Drug and Alcohol Abuse. *WHO Expert Committee on Drug Dependence. Sixteenth report. Geneva, World Health Organization, 1969 (WHO Technical Report Series, No.407. *Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Text Revision) (Diagnostic and Statistical Manual of Mental Disorders) ISBN 0890420254 *Wurmser, L. (1974) Psychoanalytic Considerations of the Etiology of Compulsive Drug Use. Journal of the American Psychoanalytical Association, 22:820 (APA) External links Expert Committee on Addiction-producing Drugs: Seventh Report. Geneva: WHO. pp. 45–47. Category:Alcohol abuse Category:Behavior disorders Category:Drug usage Category:Social issues Category:Substance-related disorders Category:Public health